GASTRO-INTESTINAL

COMPLICATIONS OF THE NEWBORN

Group members
 K. Diswane 34389814

 D. Molatedi 34740260

 N. Morale 35300523

 T. Moiloa 35480793

 L. Mokgothu 34626158

 D. Mokone 34853022

 T. Mahlakwana 36380415
Learning Outcomes

1. Identify failure to thrive in the newborn infants and discuss the reasons
and management thereof
• Vomiting
• Milk Imbalances
• Hypo/Hypertonia
 2. Discuss Feeding options for infants that are unable to breastfeed.
 3. Differentiate between and discuss the management of life-threatening
conditions of the GIT such as
• Necrotising enterecolitis
• Exomphalos
• Gastroscisis
 Failure to Thrive
 VOMITING
 Any fluid coming out from the mouth represents vomiting.

 Types of vomiting

 Bile-stained vomit (caused by any obstruction of the bile ductus). This may indicate bowel obstruction and the possible causes are
malrotation and volvulus, resulting in bowel damage and bowel loss.)
 Blood-stained vomit (caused by swallowed maternal blood at birth or during breastfeeding with cracked nipples)
 Milk vomit (caused by overfeeding or not burping the baby after feeds. Baby not absorbing feeds).
 Vomited mucus is usually caused by liquor or blood swallowed during birth

 Other causes of bile-stained vomit:

 Infection
 Bowel atresias
 Meconium ileus

 Necrotizing enterocolitis
Other causes relating to vomiting
High intestinal obstruction :
 Oesophageal fistula
 Pylorospasm ( a spasm of the pyloric sphincter of the stomach).

Metabolic, biochemical, endocrine and other disorders:

 Septicaemia
 Meningitis
 Galactosaemia
 Urinary tract infection
 Management

Bile-stained:
 Examine the baby for abdominal distention or tenderness. Check if the anus is patent, send the baby for X-ray
and contrast study to rule out bowel obstruction and malrotation.

Blood-stained (Haematemesis):
 If the blood is swallowed, the condition is self-limiting and requires no specific treatment.
 If the cause is cracked nipples, appropriate treatment must be implemented for the mother (Marshall et al ,
2016:639).

Milk Vomit:
 Avoid overfeeding and burp baby after feeds.
 Give smaller feeds and more frequent feeds.
 Compare input and output of feeds to check absorption.
 Milk Imbalances
 What is milk imbalance....
 -foremilk or hindmilk imbalance also known as lactose overload can happen when a baby have a trouble digesting the lactose in breastmilk due to
overfeeding, feeding that is low in fat or feeding in large volume, The undigested lactose has nowhere to go but the large intestine where it gets
fermented and create a lot of gas
Signs and Symptoms include
 -crying and being irritable and restless after a feeding
 -changing in stools consistency like green coloured, watery, or foamy stools
 -fussiness after feeding
 -trouble sleeping
 -bloating
 -more gas than usual
 -more appetite than usual
Management
 -Refraining from switching from one breast to another quickly (less than 5 to 10 minutes each) when feeding your baby. Increasing the length of
feeding on each breast can help.
 -Feeding your baby before he or she becomes excessively hungry to prevent aggressive sucking that could lead to oversupply.
 -Switching up your feeding positions frequently, such as side-lying position or having a mom lean very far when feeding.
 -Giving your baby a small break when they sputter off the breast. You can let your excess milk drain into a cloth or towel.

 HYPERTONIA
 Hypertonia refers to too much muscle tone in their body, this makes it
difficult to flex and move around normally.
 There are two types of hypotonia, namely spastic and dystonic hypertonia.
Spastic hypertonia causes the body to have random and uncontrollable
muscle spasms. The spasms can affect one or multiple muscle groups
throughout the body. The primary cause of this type comes from injury to
the spinal cord or brain. Dystonic hypertonia is known for causing muscle
rigidity and lack of flexibility. This condition can lead to an involuntary
posture due to the inability to stretch the muscles. Dystonic hypertonia is
commonly associated with Parkinson's Disease.
 The general cause of hypertonia is caused by an injury in the baby’s
central nervous system and results in the baby not being able to control
their muscle tone and reflexes. The injury can happen while the baby is
developing in the womb, during the delivery process, or shortly after birth,
but the condition is closely associated with birth injuries such as a head
injury or lack of oxygen while traveling down the birth canal. This is also
why hypertonia is often diagnosed with cerebral palsy, another condition
that occurs due to birthing injuries.
 HYPERTONIA
 The treatment for hypertonia includes a variety of
muscle relaxant medications and continuous physical
therapy.
 The three most popular medications used for the
condition are Baclofen, Diazepam, and Dantrolene. The
type of medication will depend on the underlying cause
of the condition.
 HYPOTONIA
 Hypotonia, also known as floppy infant syndrome, refers to decreased
muscle tone and increased flexibility, which makes the body of the
baby appear floppy and limp.
 This condition makes it difficult for the infant to lift their limps and will
affect the fine and gross motor skills of the infant as they get older.
This includes the child having difficulty sitting up with no support,
feeding themselves, and using coordinated controlled movements.
 Hypotonia has a similar cause to hypertonia in that they are both
caused by an abnormal control of the muscle tone resulting from birth
injuries.
 However, this condition can also be caused by muscular dystrophy,
spinal muscular atrophy and serious infections such as meningitis. The
birth injuries that that are commonly associated with the condition are
head and spinal cord injuries. Cerebral palsy is also closely associated
with hypotonia.
 HYPOTONIA
 The treatment for hypotonia depends on the
underlying cause of the condition as well but
generally the treatment aims to improve and support
muscle function. Common treatments include
physiotherapy, occupational therapy, and speech
therapy.
 ALTERNATIVE FEEDING METHODS FOR
INFANTS THAT ARE UNABLE TO
BREASTFEED
Cup feeding, spoon feeding, syringe feeding, lactation aid at the breast, finger feeding, paced bottle
feeding
1. Cup feeding
 •It is most successful when the baby is able to control the pace and amount of the milk flow. The
baby sips or laps the milk from the cup.
 •Cup feeding encourages the baby’s tongue to move downward and forward to sip or lap up the
supplement from a small cup.
 • It should be evaluated frequently since the equipment is easier to clean and be used on a short-term
basis.
 • The baby may take at least 5ml of the supplement at first depending on his/her satiation, the reason
for cup feeding, age and status of the baby. The baby may hold the milk in his mouth until there is
enough volume for a bolus to trigger swallowing.
 • It has been found to support infant physiological stability and to be both effective and time efficient.
2. Spoon feeding
 • This method can be used when the small cup is not available. Offer a small amount of supplement
on a spoon to calm a fussy baby or awaken a drowsy baby.
 •A spoon is an easy and accessible way to offer a small volume of milk to a baby, such as colostrum.
 • The baby may take at least 5ml of the supplement at first depending on his/her satiation, the reason
for spoon feeding, age of the baby.
 •The baby always leads and control the pace of the milk .
 Cont…
 3. Syringe feeding
 •Syringe feeding is almost similar to cup feeding. An eye-dropper can also be used.
 • Syringe or eye-dropper feeding is most successful when it follows the principles of baby-led practices and the baby
is able to control the pace of the milk flow.
 • The baby may only take 5–10 ml of the supplement at first depending at the baby’s satiation, reason for syringe
feeding, age of the baby.
 • The baby always leads and controls the pace.
4. Lactation Aid at the Breast .
There are three types of lactation aids:
 Lactation aid using a bottle
 Lactation aid using a syringe
 Commercial lactation aid.
Support the mother in understanding that:
 • A lactation aid at the breast provides additional
 breast milk during breastfeeding if the baby is able
 to latch, form a seal at the breast while providing
 stimulation to the breast and helps to increase breast milk supply. The lactation aid at the breast allows the baby to
receive a supplement and breastfeed at the same time. The lactation aid is a feeding tube connected to a supply of
 Cont…
 5. Paced Bottle Feeding
 • Paced bottle feeding is an approach to feed a baby with a bottle when the baby is unable to feed at the breast and the mother has made an
informed decision to feed with a bottle.
 • The mother has to watch for the baby's early feeding cause so that the baby can be fed in a calm state.
 • Hold the baby in an upright position, supporting the shoulders and neck, so that the baby’s neck can extend back into the natural drinking
position, like breastfeeding.
 • Use a slow-flow nipple
 • Wait for an indication of the baby’s readiness to accept the bottle – opening the mouth.
 • See that the entire nipple is in the baby’s mouth.
 • Tip the bottle just enough that there is milk in the nipple. At the beginning of the feeding, the bottle will be almost horizontal, and slowly
becomes more angled as the feeding progresses.
 • Watch the baby for coordinated breathing, sucking and swallowing – or signs of distress. Pause the feeding frequently (about every 3
swallows) to mimic the pattern and pace of breastfeeding. To pause, lower the tilt of the bottle or removing the bottle from the baby’s mouth.
 • Let the baby determine how much milk to take and when to stop feeding. Do not try to encourage the baby to finish the bottle. The feeding
will likely take as long as an effective breastfeeding, once breastfeeding is established.
6. Finger feeding
 • The method is temporary when the baby is unable to latch, attach the tube to one of the caregiver’s fingers and connect to a supply of EBM
to provide supplementation to the baby.
 •Finger feeding can facilitate proper use of the oral muscles, promoting coordination of suck-swallow- breathing to help the baby develop
effective rooting, latching, and sucking patterns.



 https://www.toronto.ca/wp-content/uploads/2017/11/96b5-tph-breastfeeding-protocol-18-alternate-feeding-2013.pdf
Cont…

 •Support the mother in understanding the possible benefits and risks associated with the
use of finger feeding.
 •explore with the mother any possible contributing factors related to the need for
possible supplementation, as well as her breastfeeding self-efficacy prior initiating finger
feeding.
 LIFE THREATENING
CONDITIONS OF THE GIT
DEFINITION OF Necrotising enterocolitis
 It is a gastrointestinal condition characterised by necrosis of part of or all of the
small and large intestine
 Predisposing factors
 Low birth weight babies who are not being breastfed or given breastmilk
 Birth asphyxia and
 Umbilical catheterization >which cause ischaemia and damage to the gut and
shock
 CLINICAL SIGNS
 Abdominal distension and ileus - abdominal tenderness
 Bile stained vomit
 Signs of septiceamia and often shock
 GI bleeding- blood in stools
 Symptoms may progress rapidly ->abdominal discoloration, with intestinal
perforation and peritonitis, and systematic hypotension requiring intensive
support
 Cont…
 DIAGNOSIS
 X-ray-->air in the bowel confirming the condition
 Ultrasound- identifies areas affected, ascites and or abscess consistent with walled-off perforation
 Hb-> loss of blood
 Low serum bicarbonate (<20) in babies with poor tissue perforation, sepsis and bowel necrosis.
 Treatment
 Immediately stop oral feeding and keep the baby NiL per Os
 Start IV infusion and TPN at prescribed rate
 NG tube to relieve bowel distension
 Give antibiotic therapy IV as prescribed
 Sometimes therapy may be required
 !!! This condition is associated with high rate of neonatal mortality!!!
 Exomphalos

 It is a congenital abnormality in which the organs of

the abdomen stick out through an opening in muscles
in the area of the umbilical cord. These organs are
then covered by a transparent membrane called the
peritoneum.
Management
 The covering membrane may burst at delivery
therefor after birth the cord should be clamped well
away from the exomphalos.
 The abnormality should be should be covered with a
sterile gauze or plastic wrapping.
 All infants with this congenital abnormality should
be transferred to Neonatal ICU
 Gastroschisis


 According to (Miles ; 2016, 650-651) gastroschisis a paramedian defect of the

abdominal wall with extrusion of bowel that is not covered by peritoneum.
Closure of the defect is usually possible; the size of the defect will determine
whether early primary closure is possible or whether a temporary silo made
from synthetic materials is necessary until the abdominal cavity is able to
contain all the abdominal organs.
 In simple term, Gastroschisis occurs when an opening forms in the baby’s
abdominal wall. Baby’s bowel pushes through this hole, the bowel then
develops outside is the baby’s body in the amniotic fluid.
 This condition develops in a baby while a woman is pregnant, the condition is
unknown and very rare.
 MANAGEMENT
- The immediate management is to cover the herniated abdominal contents
with clean cellophane wrap or warm sterile saline swabs to reduce fluid and
heat loss and to give a degree of protection.
- An orogastric or nasogastric tube should be passed, and stomach contents
aspirated
- Transfer the baby to a surgical unit.
 References
 Nall, R. 2016, 19 Feb. Does My Breast-Fed Baby Have a Foremilk and Hindmilk Imbalance? [Blog post]
https://www.healthline.com/health/parenting/foremilk-hindmilk-imbalance Date of access: 2 May 2023.
 Toronto Public Health. 2013. The breastfeeding protocols for healthcare providers.
https://www.toronto.ca/wp-content/uploads/2017/11/96b5-tph-breastfeeding-protocol-18-alternate-feedin
g-2013.pdf
Date of access: 2 May 2023.
 Birth Injury Help Centre. 2023. What is hypertonia and hypotonia?
https://www.birthinjuryhelpcenter.org/hypertonia.html Date of access: 3 May 2023.
 Harrison, V.C. 2012. The newborn baby. 6th ed Cape Town: Juta &amp; Co Ltd.
 Marshall JE, Raynor MD, Nolte AG. 2016. Myles Textbook for Midwives, 16e. African Edition.

 Woods, D. 2017. Newborn care: A learning programme for professionals. Perinatal Education
Programme. EBW Healthcare. Cape Town. ISBN (PDF ebook): 978-1-920218-57-7

 Sellers, MC.2018. Sellers’ Midwifery. 3rd ed Cape Town: Juta and company ( Pty) Ltd.